Diagnosis

Determine if other psychiatric or general medical conditions are present

Should include but is not limited to:

Physical exam

History of past and current illnesses

General medical history

Psychiatric history

To include symptoms of mania because presence of manic symptoms would prompt that the patient be diagnosed with bipolar disorder

Family history of psychiatric disorders

Substance abuse history

Medication review

Mental status evaluation

Diagnostic tests as indicated

Evaluation of functional impairment

Evaluation of life events and stressors

Evaluation

Diagnostic Criteria

Based on DSM-5 diagnostic criteria, major depressive disorder is diagnosed when 5 or more of the following symptoms that causes change or distress in previous functioning have been present during the same 2 week (and at least one of the symptoms is either depressed mood or lack of interest or pleasure):

Depressed mood in adults or irritable mood in children that either self-reported or observable most of the day, nearly daily

Lack or diminished interest or pleasure in almost all activities most of the time, nearly daily

Significant weight loss, weight gain or appetite disturbance in adults. While in children, this can be failure to attain expected weight gain

Sleep disturbance that can be insomnia or hypersomnia nearly daily

Psychomotor agitation or retardation

Feeling of fatigue or lack of energy nearly daily

Feelings of being insignificant

Inability to concentrate and there is indecisiveness

Frequent thoughts of death, could be of suicidal attempts, with or without specific plan

The symptoms should not be caused by any substance as well as any general medical condition

The disorder occurrence is not due to schizoaffective disorder, schizophrenia, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorders

Manic and hypomanic episodes have not occurred

Distinguishing between normal sadness and grief from major depressive disorder is important

Bereavement induces great suffering but does not typically induces major depressive disorder

When bereavement and major depressive disorder concurrently exist, the latter has more severe symptoms and functional impairment and worse prognosis compared to bereavement alone

Diagnosis of major depressive disorder in a patient who had significant loss would need clinical judgment based on the patient’s history and cultural context for expression of grief

Posttraumatic growth (PTG) in head and neck cancer survivors is lower than in other cancer types, a recent study has shown. Moreover, improving PTG may have positive impact on health-related quality of life.

Adding increased activity or energy as part of DSM-5 criterion A reduces the prevalence of manic and hypomanic episodes, a new study suggests. However, the new criterion does not affect longitudinal clinical outcomes.